A very simple guide to the MDGs, global health and what comes next

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It is not clear how the post-2015 goals will be framed, but health will undoubtedly play a crucial role

The Millennium Development Goals (MDGs) will expire in 2015. As we approach the deadline, it is clear that the next development framework needs to be in place to take over. Discussions at the highest level have begun. British prime minister David Cameron is an important player of the process being led by the United Nations. Development agencies and civil society groups are already jostling for position and trying to ensure what they think what should come next is included and the issue of global health is proving to be a particularly fraught one.

With this as the context, it is expected that global news coverage of the future of the global development agenda will increase as the deadline gets closer and decisions are made. This article therefore aims to provide the basics that everyone should know if they want to understand what is at stake.

What are the Millennium Development Goals?

In 2000, world leaders came together at United Nations Headquarters in New York to develop a blueprint agreed by all the world’s countries and all the world’s leading development institutions. This blueprint committed their nations to a new global partnership to reduce extreme poverty and set out a series of eight time-bound targets, otherwise known as the MDGs.

By 2015, the eight MDGs aim to:

MDG 1: eradicate extreme poverty and hunger

MDG 2: achieve universal primary education

MDG 3: promote gender equality and empower women

MDG 4: reduce child mortality

MDG 5: improve maternal health

MDG 6: combat HIV/AIDS, malaria and other diseases

MDG 7: ensure environmental sustainability

MDG 8: develop a global partnership for development

Have they been a success?

To date the answer to this can be yes and no, depending on whom you ask. However, for the most part they can be viewed in a positive light. They have undoubtedly focussed international attention towards achieving a set of tangible results, backed by the UN system, and opened the development sector up to the general public and increased their interest. They have also made donor countries more ambitious in tackling development issues and allowed for greater coherence amongst donors.

In malaria specifically the UN estimates that the global incidence rate of malaria has decreased by 17% since 2000, and malaria-specific mortality rates by 25%. In addition, countries with improved access to malaria control interventions have seen child mortality rates fall by about 20%.

What lessons have we learnt from them?

Despite these impressive outcomes, there are still lessons that can be learned, particularly as some of the goals will not be achieved by 2015. Inevitably when progress has been made in the areas targeted by the MDGs, some issues that were excluded from the process did suffer in terms of attention and funding, with neglected tropical diseases a notable example from the health sector. There has also been a tendency to focus on easy targets which offered the best chance of success, such as immediate results, rather than maximum impact on poverty reduction. This has led to inequity where the goals fail to measure and thus disregard outcomes for vulnerable and marginalized groups. These lessons can help articulate the future goals to be more balanced and context specific.

What will replace the MDGs in 2015?

This is the key question currently being discussed within the development sector and, although new thematic areas are emerging, there is widespread consensus that the future goals should focus on the poorest and most vulnerable people, not nation states. It is also agreed that these discussions must include Southern as well as Northern voices to give the process a global consensus. The post-2015 agenda is likely, therefore, to include new areas of focus such as governance, water, population dynamics, energy and economic growth.

How many goals will there be?

It is widely agreed that the number of goals should be limited to a maximum of ten, maintaining their simplicity. The UK government recently said that they “strongly support a framework with no more than ten goals, all with quantifiable targets”. Any new goals are also likely to follow the current 15 year pattern and so will set the development agenda until 2030.

How does health fit into this new framework?

With the emerging development areas noted above, which are expected to be included in the new framework, the likelihood of health having more than one goal as it does now is small. Instead there is likely to be one overarching health goal that will then be broken down into specific targets.

What will the health goal be?

As the recent WHO and Unicef led health consultation highlighted, three main health goal options have emerged:

Universal health coverage: Simply put, achieving UHC means that all people, including vulnerable, marginalised and stigmatised populations, have access to health information and services of sufficient quality to cover and fulfil the variety of their needs while protecting against the risk of financial hardship from accessing health services.

If this option is taken up then UHC must be articulated with precision and incorporate achievable targets. It also needs to be recognised that the aim of UHC should not be just coverage, but universal access to healthcare.

Healthy life expectancy: The World Health Organisation defines healthy life expectancy as the “average number of years that a person can expect to live in ‘full health’ by taking into account years lived in less than full health due to disease and/or injury”. If incorporated into the post-2015 framework, this goal will address the need for action on the determinants of health and on the root causes of ill-health, preventable disability, and premature death.

MDGs alternative: Another option is for more specific goals that resemble the current MDGs. Proponents of this option believe that the post-2015 development agenda should maintain the priorities of the MDG framework and not be designed to encapsulate everything that development seeks to achieve. The MDG framework generated resonance and buy-in because of the focus on clear, targeted, measurable outcomes that were meaningful to both the general public and policy-makers. With the broader themes offered by the alternatives, this might be lost.

When will these decisions be made?

We are currently in the midst of a number of high level consultations and conferences to discuss the post 2015 agenda. In January 2012, the UN Secretary-General established the UN System Task Team on the Post-2015 UN Development Agenda of which David Cameron is a Co-Chair, to coordinate the development of a new framework in consultation with all stakeholders on each thematic area.

The High Level Dialogue on Health in the Post-2015 Development Agenda took place in Gaborone, Botswana, from 4-6 March, 2013 and produced a report following months of consultations with civil society. This report will feed into the more general post-2015 consultative meeting in Bali, Indonesia on 25 – 27 March 2013. The findings from all the thematic consultations will be presented in a report to the UN General Assembly in September 2013 where the recommendations will be ratified.